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Background: Infantile Hemangiomas (IHs) are common, benign and self-limiting vascular malformations. A significant percent of these vascular lesions are associated with substantial morbidity and cosmetic disfigurement, therefore treatment should be initiated as soon the diagnosis is confirmed especially for the hemangiomas involving vital areas [1]. Oral propranolol has now been a time tested drug for the successful management of superficial IHs; but factors like risk of hypoglycemia, contraindication among babies suffering from allergic respiratory conditions and non-compliance in disfavor its usage in certain children [2]. Topical timolol suits well in these patients as the action is mainly localized at the site of its application. The present study was designed to compare efficacy of these two drug modalities in the treatment of superficial infantile hemangiomas. Patients and methods: This randomized controlled study included 20 children in two groups receiving either oral propranolol or topical timolol. Clinical parameters in the form of systolic and diastolic blood pressure (SBP & DBP), heart rate (HR), respiratory rate (RR), random blood sugar (RBS), oxygen saturation (SaO2), haemangioma activity score (HAS) & physician global assessment scale (PGA) were recorded and compared well in both the groups till eighteen months. Results: The groups were statistically comparable with respect to the age, sex, gestational age, birth weight and severity of the vascular lesion. Head and neck regions were most commonly involved sites. Both propranolol and timolol were found to be safe and comparable with regard to the changes in HR, respiration pattern and blood sugar levels. However, slightly low DBP was observed in the propranolol group at 20th week when compared with timolol group (p value- 0.007). On clinical analysis, fall in HAS was significantly lower in propranolol treated babies from 20th week onwards. The gain in the PGA score was more in propranolol patients and the difference was statistically significant particularly at 18 months (p value- 0.04). Conclusion: We conclude that both the treatment modalities can be administered safely. However, oral propranolol offers better results than topical timolol in terms of clinical response as a whole. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study the impact of time of day, day of week and level of patient monitoring on medical emergency team (MET) activation. DESIGN: Retrospective observational study of all MET and cardiac arrest events between October 2001 and March 2005. SETTING: University of Pittsburgh Medical Center Presbyterian Hospital, a tertiary care teaching facility in the United States. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Cardiac arrest and MET event rate during the day (7 am to 6:59 pm) and night (7 pm to 6:59 am) overall; for weekdays and weekends; and from unmonitored, monitored, and intensive care units (ICUs). There were 605 cardiac arrest and 4,072 MET events. MET event rate was higher during the day than at night in unmonitored units (62% day vs. 38% night; p < .001) and monitored units (59% day vs. 41% night; p < .001) but not in ICUs (47% day vs. 53% night; p = .20). Unmonitored units had a greater daytime increase in MET event rate than monitored units (63% vs. 46%), whereas ICUs showed an 11% decline compared with night. The MET day vs. night difference was greater on weekdays (65% day vs. 35% night; p < .001) than on weekends (56% day vs. 44% night; p < .001). Cardiac arrest event rate showed no diurnal pattern in any unit setting but had a higher daytime event rate during weekdays (57% day vs. 43% night; p = .004). CONCLUSIONS: More MET events take place during the day. MET events in unmonitored units have a greater diurnal variability than those from monitored units. ICUs show no diurnal variation in MET event rate. Our results suggest a significant variability in the hospital ability to consistently detect patients who meet MET activation criteria. [ABSTRACT FROM AUTHOR]

Study Objective: To identify the relationship between patient position during surgery and time to confirmation of ureteral patency on cystoscopy., Design: Randomized controlled trial., Setting: Academic tertiary care medical center., Patients or Participants: A total of 91 adult women undergoing laparoscopic (either conventional or robotic) hysterectomy between February 2021 and February 2022 were randomized to intervention (n = 45) or control (n = 46). Exclusion criteria included known kidney disease or urinary tract anomaly, current ureteral stent, pregnancy, malignancy, and recognized intraoperative urinary tract injury., Interventions: Subjects in the control group were placed in a 0° supine position during cystoscopy. Subjects in the intervention group were placed in a 20° angle in reverse Trendelenburg (RT) position during cystoscopy., Measurements and Main Results: The primary outcome, time to confirmation of bilateral ureteral patency, was measured at the time the second ureteral jet was viewed during intraoperative cystoscopy. There was no significant difference in mean time to confirmation (66.5 seconds in supine vs 67 seconds in RT, p = .2) nor in total cystoscopy time (111 seconds in supine vs 104.5 seconds in RT, p = .39). There were no significant differences in need for alternative modalities to aid in ureteral efflux visualization, delayed diagnosis of ureteric injury, and operative time. RT position seemed to have reduced the time to confirmation for the small group of patients with longer confirmation time (>120 seconds)., Conclusion: RT position does not change time to confirmation of bilateral ureteral patency compared with supine position. However, there may be a benefit in position change if time to confirmation is >120 seconds., (Copyright © 2022 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: Minimally invasive hysterectomy is a commonly performed gynecologic procedure with associated postoperative pain managed with opioid medications. Uncontrolled postoperative pain leads to increased opioid use/abuse, longer hospital stays, increase in healthcare visits, and may negatively affect patient satisfaction. Current data suggests that reduced pneumoperitoneum insufflation pressure during laparoscopic surgery may impact postoperative pain. Given the current opioid epidemic, surgeons are proactively finding ways to reduce postoperative pain. It is unclear how reduced pneumoperitoneum pressure impacts the surgeon. We investigated the impact of reduced pneumoperitoneum insufflation pressure on surgeon satisfaction., Study Design: This was a pilot, double-blinded, randomized controlled trial from March 2020 to July 2021 comparing pneumoperitoneum pressure of 15 mmHg to reduced pressures of 12 mmHg and 10 mmHg during laparoscopic hysterectomy., Results: A total of 40 patients were randomized (13 - 15 mmHg, 13 - 12 mmHg, and 14 - 10 mmHg). The primary outcome was surgeon satisfaction. Secondary outcomes included patient satisfaction, operative time, blood loss, postoperative pain, opioid usage, and discharge timing. There were no differences in baseline demographics or perioperative characteristics. Surgeon satisfaction was negatively impacted with lower pneumoperitoneum pressures greatest with 10 mmHg, including overall satisfaction (p =.01), overall effect of the pneumoperitoneum (p =.04), and quality of visualization (p =.01). There was an apparent although not statistically significant difference in operative time (p =.06) and blood loss (p =.054). There was no difference in patient satisfaction, postoperative pain scores, opioid usage, or time to discharge., Conclusion(s): Reduced pneumoperitoneum insufflation pressure during laparoscopic hysterectomy negatively impacted surgeon satisfaction with a trend towards longer operative times and greater blood loss, and did not positively impact patient satisfaction, postoperative pain, opioid demand, or discharge timing., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose of Review: The purpose of this review is to summarize the current literature evaluating the effect of surgeon gender on patient outcomes and satisfaction, and the impact of gender bias on female surgeons., Recent Findings: The proportion of female physicians has increased in recent years, especially in Obstetrics and Gynecology. Recent literature assessing this impact supports equivalent or superior medical and surgical outcomes for women surgeons and physicians. It also reveals superior counseling and communication styles as perceived by patients. However, women in medicine receive lower patient ratings in competence, medical knowledge, and technical skills despite the existing evidence. Additionally, female physicians experience pay inequality, limited advancement opportunities, higher prevalence of microaggressions, and higher rates of burnout., Summary: Recognition of gender bias is essential to correcting this issue and improving the negative impact it has on female physicians, our patients, and the field of women's health., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

The deployment of machine learning (ML) systems in applications with societal impact has motivated the study of fairness for marginalized groups. Often, the protected attribute is absent from the training dataset for legal reasons. However, datasets still contain proxy attributes that capture protected information and can inject unfairness in the ML model. Some deployed systems allow auditors, decision makers, or affected users to report issues or seek recourse by flagging individual samples. In this work, we examine such systems and consider a feedback-based framework where the protected attribute is unavailable and the flagged samples are indirect knowledge. The reported samples are used as guidance to identify the proxy attributes that are causally dependent on the (unknown) protected attribute. We work under the causal interventional fairness paradigm. Without requiring the underlying structural causal model a priori, we propose an approach that performs conditional independence tests on observed data to identify such proxy attributes. We theoretically prove the optimality of our algorithm, bound its complexity, and complement it with an empirical evaluation demonstrating its efficacy on various real-world and synthetic datasets.

Study Objective: To evaluate and compare the recall rates of obstetric and gynecologic devices approved via the Food and Drug Administration's 510(k) and premarket approval (PMA) processes., Design: A retrospective observational study (Canadian Task Force classification II-2)., Setting: Clinical settings in the United States that use obstetric and gynecologic devices., Subjects: Two thousand two hundred forty-nine Food and Drug Administration-approved obstetric and gynecologic devices that were recalled between November 1, 2002, and December 31, 2017., Measurements and Main Results: The class of device, class of recall, date of recall, and original approval process were obtained for each device. These were compared against the total number of approved devices during this time period in the PMA and 510(k) processes. Recall proportions of each process were calculated and compared. A total of 685 devices were approved via the PMA process, and 1564 devices were approved via the 510(k) process in the observed time period. Of these, 1.17% of the PMA-approved devices and 15.98% of the 510(k)-approved devices were recalled (p < .001). There was an overall increase in absolute device recall numbers over time in the 510(k) process, whereas the number of recalls in the PMA process did not change with time., Conclusion: The recall event rate for the 510(k) approval process is 13.6 times the rate for the PMA approval process for obstetric and gynecologic devices. Analysis of the results suggests improper device risk classification, inappropriate assignment of the approval process, increased device malfunctions, recalls by the 510(k) process and, therefore, increased risk to patients by these devices. This warrants a call for improvement and increased scrutiny in the 510(k) approval process for devices used in obstetrics and gynecology., (Copyright © 2018 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.)

Introduction: Resistance to antimicrobial agents is a major concern worldwide and is exemplified by the global spread of the Methicillin resistant Staphylococcus aureus (MRSA). Health care workers (HCWs) and asymptomatically colonized patients are important sources of nosocomial MRSA infections., Aims and Objectives: To determine the prevalence of MRSA colonisation, two hundred HCWs and 200 consecutive outpatients attending our tertiary care hospital were studied., Material and Methods: Two sterile pre-moistened cotton tipped swabs were used to collect specimens from their anterior nares. These were inoculated immediately on Blood agar with oxacillin, Mannitol salt agar with oxacillin and CHROM agar. Resistance to cefoxitin was confirmed by PCR by demonstration of mecA gene. Antibiotic susceptibility was determined by Kirby Bauer's disc diffusion method and MIC of vancomycin by using broth dilution and Vitek-2 Compact system., Results: The nasal carriage of MRSA among HCWs was found to be 7.5% and in outpatients 3%. All strains of MRSA from HCWs and outpatients grew on three selective media and mecA gene amplified in all of them. All the isolated strains of MRSA showed high degree of resistance to co-trimoxazole (93.3%), ciprofloxacin (80%) and erythromycin (66.66%). However, there was 100% susceptiability to vancomycin, teicoplanin, linezolid and Rifampicin., Conclusion: Although a direct casual relationship could not be established, it could be assumed that the transmission from colonised health care worker is responsible atleast in part for MRSA infection among patients. Therefore emphasis should be laid on strict implementation of standard infection control practices which would help in minimizing the carriage and transmission of MRSA in the hospital., Competing Interests: There are no conflicts of interest.

Recently, a number of techniques have been approved for quantification of viral nucleic acids in clinical samples. Viral load (VL) tests have considerable importance in the management of patients and are widely used in routine diagnosis. In clinical virology, VL testing are important to monitor the antiviral treatment, to initiate preemptive therapy, to understand pathogenesis, and to evaluate the infectivity. These tests have now become a part of many diagnostic and treatment guidelines. Considering the various challenges for in-house viral testing related to the standardization, validation, and precision; they are gradually being replaced by the United States Food and Drug Administration (US FDA) cleared tests. This review summarizes the various viral quantification methods and also discusses the clinical applicability of these in human immunodeficiency virus, Hepatitis B virus, Hepatitis C virus, Cytomegalovirus, and Epstein Barr virus infected patients. Further the challenges and future perspectives of VL testing have also been discussed., Competing Interests: There are no conflicts of interest.

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent significant public health issues globally. They are important causes of morbidity and mortality in hemodialysis patients. Patients with HBV/HCV co-infection have a higher risk of progression to cirrhosis and decompensated liver disease and have an increased risk of hepatocellular cancer (HCC). Because the two hepatotropic viruses share same modes of transmission, co-infection with the two viruses is not uncommon, especially in areas with a high prevalence of HCV infection and among people at high-risk for parenteral infection., Aims: To estimate the prevalence of HBV and HCV co-infection among hemodialysis patients., Materials and Methods: This retrospective, single centered hospital record-based study was carried out in a tertiary care hospital in Faridkot (Punjab), India. All the patients who underwent hemodialysis from January 2013 to December 2014 were included in the study. Patients of all age groups were tested for anti-HCV antibodies by fourth Generation HCV Tridot ELISA (J. Mitra & Co. Pvt. Ltd., New Delhi, India) and for hepatitis B surface antigen (HBsAg) by Hepalisa (J. Mitra & Co. Pvt. Ltd)., Results: Of the total 262 patients on hemodialysis, 88 (33.5%) were found to be having HCV infection, 4 (1.5%) were found to be positive for HBsAg. Co-infection with HBV/HCV was observed in 2 (0.8%) patients. Out of the total 92 patients having HBV and HCV infection, 62 (67.4%) were males and 30 (32.6%) were females. The majority of the patients were found to be of 41-60 years of age (41.3%) followed by 21-40 years (31.5%) and thereafter in 61-80 years (23.9%) and lowest prevalence was observed in the age group of <20 years (2.2%) and >80 years (1.1%)., Conclusion: The risk of co-infection is greater among the chronic renal failure (CRF) patients due to the high frequency of transfusions of blood/blood products and extracorporeal circulation during hemodialysis. Patients with HBV/HCV co-infection have a higher risk of progression to cirrhosis and decompensated liver disease and further have an increased risk of HCC. In our study, out of the total 262 patients, 88 (33.5%) were found to be having HCV infection, 4 (1.5%) were found to be positive for HBsAg and dual infection was observed in 2 (0.8%) patients which is higher than the rates reported from different studies all over the world and India.

Scrub typhus is re-emerging in India. We describe an outbreak of 45 cases from our tertiary care center in north India. This outbreak included city dwellers who had no history of travel to hilly areas. The classical feature of scrub typhus, the eschar, was also noted rarely in these patients. The changing epidemiology of scrub typhus should be kept in mind while attending patients with acute febrile illness., (© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

We show that in a reaction diffusion system on a two-dimensional substrate with advection in the confined direction, the drift (advection) induced instability occurs through a Hopf bifurcation, which can become a double Hopf bifurcation. The box size in the direction of the drift is a vital parameter. Our analysis involves reduction to a low dimensional dynamical system and constructing amplitude equations.

It has been well established that there are racial and ethnic disparities in cardiovascular care. Quality improvement initiatives have been recommended to proactively address these disparities. An initiative was implemented to improve timeliness of and access to primary percutaneous coronary intervention (PCI) procedures among myocardial infarction patients at an academic medical center serving a predominantly minority population. The effort was part of a national quality improvement collaborative focused on improving cardiovascular care for Hispanic/Latino and African American/ black populations. The proportion of primary PCI procedures performed within 90 minutes improved significantly from 17% in the first quarter of 2006 to 93% in the fourth quarter of 2008 (P < .001). There were no significant differences in the frequency with which Hispanic/Latino or African American/black patients received primary PCI therapy in comparison to nonmembers of these groups. Quality improvement techniques can improve the quality of and access to acute cardiovascular care for minority populations.

The authors describe two cases in which Günther Tulip inferior vena cava filters migrated to the chest, necessitating open-heart surgery for retrieval. In the first case, a 52-year-old man was transferred to their hospital from an outside facility after the filter migrated to the main pulmonary artery during attempted filter placement. In the second case, a 72-year-old man, a Günther Tulip filter was found to have migrated to the tricuspid valve after cardiopulmonary arrest and subsequent resuscitation, including emergent central venous line placement. The authors present the relevant details of both cases, discuss possible preventive strategies, and review the available literature about migration of the Günther Tulip filter.

Objective: To study the incidence, outcome and potentially avoidable causes of inpatient cardiopulmonary arrests in a hospital with a "mature" rapid response system (RRS)., Design: Retrospective observational study of all cardiopulmonary arrest events in 2005., Setting: University of Pittsburgh Medical Center Presbyterian Hospital, a 730-bed academic, urban, tertiary care adult hospital in the USA., Interventions: None., Results: During the calendar year 2005, the 16th year since the establishment of a medical emergency team (MET)/RRS, the MET was activated 1942 times; 111 of these events were cardiopulmonary arrest events (3.26 arrest events/1000 patient admissions), and 1831 were non-arrest patient crisis events (53.8 crisis events/1000 patient admissions). A review of the 104 index cardiopulmonary arrest events revealed that 26 (25%) patients survived to discharge. Event survival decreased as the intensity of patient monitoring decreased (83% in intensive care units, 69% in monitored, and 36% in unmonitored units; p = 0.002), but the rate of subsequent in-hospital death was higher in the more intensely monitored settings (60%, 38%, 23%, respectively; p = 0.022). Nineteen (18%) arrests were deemed to be "potentially avoidable". Avoidable arrests were classified as: failure to adhere to established hospital patient care guideline or policy; inadequate monitoring or surveillance; or delays in dealing with patient needs including delay in MET/RRS activation., Conclusions: In spite of the high crisis event rate and a low rate of cardiac arrests, potentially avoidable cardiopulmonary arrests still occurred. According to the present study more cardiopulmonary arrest events might be avoided by better adherence to hospital patient care policies, by closer monitoring on floors and by preventing delays in addressing deterioration in patient condition.

Background: Studies have established that physiologic instability and services mismatching precede adverse events in hospitalized patients. In response to these considerations, the concept of a Rapid Response System (RRS) has emerged. The responding team is commonly known as a medical emergency team (MET), rapid response team (RRT), or critical care outreach (CCO). Studies show that an RRS may improve outcome, but questions remain regarding the benefit, design elements, and advisability of implementing a MET system., Methods: In June 2005 an International Conference on Medical Emergency Teams (ICMET) included experts in patient safety, hospital medicine, critical care medicine, and METs. Seven of 25 had no experience with an RRS, and the remainder had experience with one of the three major forms of RRS. After preconference telephone and e-mail conversations by the panelists in which questions to be discussed were characterized, literature reviewed, and preliminary answers created, the panelists convened for 2 days to create a consensus document. Four major content areas were addressed: What is a MET response? Is there a MET syndrome? What are barriers to METS? How should outcome be measured? Panelists considered whether all hospitals should implement an RRS., Results: Patients needing an RRS intervention are suddenly critically ill and have a mismatch of resources to needs. Hospitals should implement an RRS, which consists of four elements: an afferent, "crisis detection" and "response triggering" mechanism; an efferent, predetermined rapid response team; a governance/administrative structure to supply and organize resources; and a mechanism to evaluate crisis antecedents and promote hospital process improvement to prevent future events.

Data from single 10-minute magnetic resonance scans were used to create three-dimensional (3-D) views of the surfaces of the brain and skin of 12 patients. In each case, these views were used to make a preoperative assessment of the relationship of lesions to brain surface structures associated with movement, sensation, hearing, and speech. Interactive software was written so that the user could "slice" through the 3-D computer model and inspect cross-sectional images at any level. A surgery simulation program was written so that surgeons were able to "rehearse" craniotomies on 3-D computer models before performing the actual operations. In each case, the qualitative accuracy of the 3-D views was confirmed by intraoperative inspection of the brain surface and by intraoperative electrophysiological mapping, when available.

We have investigated the application of computer-based methods to the detection of microcalcifications in digital mammograms. The computer detection system is based on a difference-image technique in which a signal-suppressed image is subtracted from a signal-enhanced image to remove the structured background in a mammogram. Signal-extraction techniques adapted to the known physical characteristics of microcalcifications are then used to isolate microcalcifications from the remaining noise background. We employ Monte Carlo methods to generate simulated clusters of microcalcifications that are superimposed on normal mammographic backgrounds. This allows quantitative evaluation of detection accuracy of the computer method and the dependence of this accuracy on the physical characteristics of the microcalcifications. Our present computer method can achieve a true-positive cluster detection rate of approximately 80% at a false-positive detection rate of one cluster per image. The potential application of such a computer-aided system to mammographic interpretation is demonstrated by its ability to detect microcalcifications in clinical mammograms.